title: Ocular surface squamous neoplasia as the first apparent  manifestation of HIV infection in Malawi.
abstract: OBJECTIVE
  To evaluate the prevalence of undiagnosed and asymptomatic HIV infection in patients with ocular surface squamous neoplasia (OSSN) in an urban patient population in Malawi.
  
  
  METHODS
  A consecutive series of patients presenting with OSSN was evaluated in an African academic centre. A detailed history and physical examination in 53 consecutive patients with conjunctival squamous cell carcinoma and conjunctival intraepithelial neoplasia were performed. Thirty eight (72%) patients agreed to undergo serological HIV testing.
  
  
  RESULTS
  Seventy-nine per cent (30 of 38) patients were HIV positive. None of the patients had previous HIV testing or was aware of having symptoms of HIV. Seventy per cent (n = 21) of the HIV-positive patients had no other symptoms suggestive of HIV infection or any other disease. Patients were far more likely to refuse HIV testing if they were married and male.
  
  
  CONCLUSIONS
  The conjunctival tumour may be the primary and only apparent manifestation of HIV in patients presenting with OSSN in Sub-Saharan Africa.
authors.affiliation: Lion's Sight First Eye Hospital, College of Medicine, Blantyre, Malawi. martin.spitzer@med.uni-tuebingen.de
authors.forename: Martin S
authors.initials: MS
authors.lastname: Spitzer
authors.forename: Nkume H
authors.initials: NH
authors.lastname: Batumba
authors.forename: Tamara
authors.initials: T
authors.lastname: Chirambo
authors.forename: Karl U
authors.initials: KU
authors.lastname: Bartz-Schmidt
authors.forename: Petros
authors.initials: P
authors.lastname: Kayange
authors.forename: Khumbo
authors.initials: K
authors.lastname: Kalua
authors.forename: Peter
authors.initials: P
authors.lastname: Szurman
mesh_terms: D000328:Adult; D002278:Carcinoma in Situ / Q000473:pathology / Q000821:virology*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000821:virology*; D003230:Conjunctival Neoplasms / Q000473:pathology / Q000821:virology*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000503:physiopathology; D006562:Herpes Zoster / Q000150:complications; D006801:Humans; D008295:Malawi; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D014376:Tuberculosis / Q000150:complications; D015431:Weight Loss